Cardiothoracic Surgery |

Pulmonary Sequestration: Case Series Review of 29 Patients in the Cleveland Clinic Health System FREE TO VIEW

Basheer Tashtoush; Roya Memarpour; Jose Gonzalez; Anas Hadeh; Gustavo Ferrer; Laurence Smolley
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Cleveland Clinic Florida, Weston, FL

Chest. 2014;146(4_MeetingAbstracts):92A. doi:10.1378/chest.1983679
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary sequestration (PS) is a rare entity, comprising only 0.15 - 6.4% of all lung malformations, with very few case series reviewed in literature. In this study, we reviewed the demographics, presentation, diagnosis, and treatment of pulmonary sequestration in 29 patients in the Cleveland Clinic Health System (CCHS).

METHODS: A retrospective chart review of patients evaluated and treated in the CCHS with a pathological proven diagnosis of PS from January 2004 through December 2013. Electronic medical records were utilized to identify patients with the diagnosis of PS. Imaging studies were reviewed by radiologists at Cleveland Clinic. We excluded patients whose diagnosis was made in an outside facility and had no imaging studies available for the review. Reviewed data included demographics, clinical presentation, diagnostic imaging, location of the lesion and subsequent treatment.

RESULTS: Of the twenty nine patients, 15 were males and 14 females. Eight children 0-2 years old, one adolescent age 17, and twenty adults 21-70 years old with a median age of 41 at the time of diagnosis. In adults, symptoms occurred in 17 patients, with the most common presentation being cough associated with recurrent pulmonary infections (12 patients), hemoptysis (3 patients) and chest pain as the primary complaint (2 patients). Systemic arterial supply to the sequestered segment was demonstrated with CTA in 25 patients (86% of cases), with a sensitivity of 85%. In four patients, where CTA failed to demonstrate the arterial supply, two were diagnosed with angiography and two others with MRA. In 19 patients (66%), the PS was located in the left lower lobe and 16 (55%) were intralobar. All children and symptomatic adults were treated surgically with resection of the sequestered segment, and 2 patients underwent preoperative embolization.

CONCLUSIONS: Diagnostic delays were common among adults where symptoms often mimicked recurrent pulmonary infections. Chest CTA had high sensitivity in identifying the lesion and served as the single imaging modality for preoperative planning in the majority of patients.

CLINICAL IMPLICATIONS: The advent of sophisticated imaging techniques, such as helical CTA and 3D reconstruction imaging, may replace angiography as the tool of choice for identifying the arterial supply in PS and further operative planning. CTA was enough to guide therapeutic decisions; however, MRA can be used as an alternative when CTA fails to identify the aberrant vessels supplying the sequestered segment.

DISCLOSURE: The following authors have nothing to disclose: Basheer Tashtoush, Roya Memarpour, Jose Gonzalez, Anas Hadeh, Gustavo Ferrer, Laurence Smolley

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